Eczema or atopic dermatitis (AD) is the most common chronic inflammatory skin disease. The prevalence has been increasing worldwide. People with eczema experience severe itching, skin redness and dryness, weeping and scarring. Eczema tends to flare and then subside. Eczema affects daily activities and results in tremendous medical expenditures; the national burden was reported to range from $364 million to $3.8 billion.
Who gets eczema?
Eczema could develop in any age group, but is most common in infants and young adults. The estimated prevalence of eczema is approximately 10 to 30 percent in children and 2 to 10 percent in adults.
There are three subsets of eczema based on age of onset;
1) Early-onset type starts in the first 2 years of life. Most children outgrow it by the age of 10, but others continue to have problem on and off throughout life. Notably, East Asian infants are at increased risk of eczema.
2) Late-onset type begins after puberty.
3) Senile-onset type starts after 60 years of age.
What causes eczema?
Although the exact cause is not known yet, it is thought to be a complex disease where multiple factors including genetic components, epidermal barrier dysfunction and immunologic mechanisms play a role. It has been well-known that eczema is more common in families with a history of eczema, asthma or allergic rhinitis. In addition, candidate genes have been identified and are under investigation. It has been postulated that those genetically susceptible individuals may be sensitized to environmental factors such as irritants or allergens. When they encounter certain substances or conditions (rough materials, soap or detergent, respiratory infections or colds, stress), people may experience a flare-up because of an overactive immune reaction causing epidermal barrier dysfunction.
How is eczema diagnosed?
Dermatologists are specialists trained to recognize and treat eczema. Most often, it can be diagnosed by visual examination along with review of a patient’s history and/or family history of eczema. Although there are blood tests that can support the diagnosis of eczema, the diagnosis can’t be made by the blood test alone.
Can food cause eczema flare-ups?
Yes. Food allergies can cause eczema flare primarily in infants and children with severe eczema. Eggs are most often linked to eczema exacerbation among common food allergens such as milk, eggs, peanuts, soy and wheat. Identification of culprit allergens should be carefully determined based on clinical history and provocation tests. Although avoidance of food allergens could prevent flare-ups in a subset of patients, this must be balanced with the potential nutritional deprivation from unnecessary restrictive diets.
How is eczema treated?
Eczema greatly affects the quality of life due to the intense itching, sleep disturbances, psychological distress, disrupted family dynamics and impaired function at school or work. Thus, it is important to diagnose and treat eczema appropriately.
Although there is no cure, most people can effectively manage their disease with medical treatment. The goals of treatment are to reduce inflammation and itching and to prevent future flare-ups.
Currently, avoidance of triggering factors and skin care are recommended for all cases of eczema. Triggering factors include allergens (pollen, dust mites, animal dander), sweating, harsh soaps, wool or other rough fabrics, cigarette smoke and emotional stress.
For skin care, the following self-care treatments could be tried.
• Lubricate skin with moisturizing cream or ointment frequently.
• Avoid scratching as much as possible; trim nails and wear gloves especially at night.
• Water must be lukewarm not hot. Avoid long baths or showers.
• Choose mild soaps and cleansers.
• Wear cool, smooth-textured cotton clothing. Avoid closely fitting garments or clothing that is made from wool or pure synthetic fabrics.
Further treatments are decided based on the severity of the disease.
• Mild cases can be controlled by continuous use of emollients and intermittent use of topical corticosteroids for flare-ups.
• Moderate eczema requires proactive maintenance with anti-inflammatory agents.
• For severe and refractory cases, the use of phototherapy and systemic drugs may need to control the disease.
Soo Jung Kim, MD, PhD
Clinical Instructor, Dermatology
Director of the Mount Sinai Dermatology
168 Centre Street, Suite 3M
New York, NY 10013
For appointments, please call (212) 731-3610
or visit www.MountSinaiDermatology.com